Toll Free Number Port Authorization FracTEL Account Code*Numbers will be transferred to this accountCustomer InformationCustomer Business Name*Customer Business Name as it appears on current invoice.Customer Address*This should be the service address shown on current providers invoice. Use billing address if it is the same. Street Address 1 Street Address 2 City State State or ProvinceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Contact InformationAuthorized User*This must be the name of the individual who is authorized by current provider to make changes to account and who will be signing Letter of Agency. First Last Authorized User Title*Contact Email Address* Contact Phone*Telephone Number InformationCurrent Service ProviderThe name of your current toll free service provider.Enter VOICE numbers to be transferred below Enter FAX numbers to be transferred below PhoneThis field is for validation purposes and should be left unchanged.